Friday, September 15, 2017

Last Ditch Obamacare Schadenfreude

Last-chance Obamacare repeal bill includes waivers from insurance regulations
Republican senators trying a last stab at tackling Obamacare are pushing a bill that lets states partly waive key regulations that include protections for people with pre-existing conditions, an issue that has doomed other attempts at repealing former President Barack Obama's healthcare law.

The bill, co-sponsored by Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Ron Johnson of Wisconsin and Dean Heller of Nevada, seeks to provide Obamacare funding to states in the form of $1.2 trillion in block grants from 2021 to 2026.

Critics of the approach quickly said that the bill's waivers from key Obamacare insurer regulations would erode protections for people with pre-existing conditions. It also would waive essential health benefits such as maternity care or mental health.
From Wombat-socho's "In The Mailbox: 09.13.17", the usually sensible Megan McArdle discusses
The Latest (Dim, Distant) Hope for Health-Care Reform
Well, the political math certainly looks difficult. Republicans hold a majority in both houses, but their Senate majority is narrow enough to give them precious little wiggle room when it comes to passing a bill. Considering that Rand Paul has already been pretty negative about the bill, that wiggle will have to be more like a tremor: If Rand won't back the proposal, they’ll need either Susan Collins or Lisa Murkowski, who have so far proven unwilling to vote for previous iterations of GOP reform ideas.

Moreover, they’re going to have to shimmy pretty quick. This bill is not, needless to say, going to garner Democratic votes. Democrats don’t want to do anything to Obamacare except pour more money into it, and this particular version is going to hurt blue and purple states that expanded their Medicaid programs.

So to get it through the Senate, the Republican sponsors will have to use a budget process called reconciliation. The reconciliation instructions expire on Sept. 30. In that time, the bill needs to get a CBO score and work its way through the torturous parliamentary procedure for bringing a bill to the floor and voting on it, as well as the lengthy arm-twisting that will probably be required to get enough senators on board. It’s not actually impossible to meet that deadline -- but it doesn’t look all that possible, either.

The Medicaid changes are also going to be a problem for Republican senators from states that took Medicaid money, a group that includes Lisa Murkowski of Alaska (don’t count on that vote), and also true-red, die-hard conservatives like Tom Cotton of Arkansas. Whipping those votes would be a Herculean challenge, and it’s far from clear that leadership has any appetite for that fight.

And yet, readers caught in this interminable saga can’t quite say “It’ll be dead by page 900.” Nevada is an expansion state, but one of its senators, Dean Heller, is co-sponsoring the bill. Something about this bill is appealing to him, and maybe that something will appeal to the waverers among his colleagues.
Yes, but is it a good bill?
There are indeed a lot of things to like in this bill, from a Republican perspective. It shifts money toward red states and away from blue ones, and achieves a longstanding goal of block-granting Medicaid -- ending the perverse incentives created by having the states manage the program while the federal government picks up part of every bill. And it gives states more autonomy, which is consistent with both conservative philosophy and red-state interests. Obviously if you’re fond of Obamacare, this is going to seem a poor substitute. But you may have noticed that most Republican legislators aren’t particularly fond of it.

That said, it still leaves some of the regulations in place that have caused so many problems with the exchanges for individual insurance policies. Tinkering with the money side while leaving those regulations intact is a dangerous game. It’s a good idea to let states figure out how to patch the holes that Obamacare has created -- but given the sums involved, it seems eminently possible that states simply won’t be able to.
So better than Obamacare, but unlikely to pass?

Meanwhile, the Trump Administration is Working in Other Ways to Dismantle Obamacare. The let it die strategy. But Reason is pessimistic: Obamacare Repeal Is Dead. Here Come the Bailouts. I'm inclined to agree.

The Democrats, on the other hand, have become the American socialist party. One might even say that they have become our National Socialist Party.   “The Time Has Come”: ObamaCare Architect Max Baucus Endorses Single-Payer. If it was designed to fail and lead to a call for single payer, it's working. Sanders Will Introduce Universal Health Care, Backed By 15 Democrats
Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018.

The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans younger than 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
Comrade Bernie Explains Why We Need Government Run Health Care. Why Sanders’ Single Payer Bill Is The Real Dream ActBut he was honest once: Medicaid for All Would ‘Bankrupt the Nation,’ Warns Bernie Sanders—In 1987. Maybe he sees that as a feature, not a bug.

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